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Is your Practice Safe Against Fraud and Abuse Penalties?

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You hear it everyday, practices being penalized, physicians being brought to book. But like cancer it is something that happens to somebody else, unless it hits you out of the blue.

Every physician strives to work in an ethical, profitable and secure practice. With Medicare coming down heavily on physicians with improper records, it is high time physicians took a closer look at what they’re billing for.

If it is not in your Records, it never Happened !

And that is why errorless medical documentation is absolutely necessary. The AMA and other regulatory bodies stress on the importance of having clear documentation for every claim submitted. More often than not physicians’ frantically search and put together documents to substantiate their claims, after a rejection slip from the insurer. It is good practice to have the necessary documents supporting your claim prior to filing it.

Small Errors can lead to Big Repercussions.

It is disheartening that most medical practitioners, who are penalized for fraud and abuse, are victims of minor errors. The most common mistake is upcoding. Not knowing how to assign E/M codes for subsequent visits or misuse of modifier – 25 are what most practices are guilty of.

Report Over-Payments inside of 2 months…

Just spotted a billing error? Report it and return the overpaid amount to Medicare and Medicaid funds. Practices who fail to return overpayments within sixty days will be penalized under the false claims act. Regular audits and close introspection of billing reports can help practices to notice and return overpayments, before it’s too late.

The Ball is in the Doctor’s Court !

Though being responsible for so many aspects of a medical practice can be burdensome it is also highly rewarding. Physicians need to juggle a lot many tasks. But the fact that the ball is always in the physicians court, and there is a chance to correct flaws is reason enough to smile.

Physicians need to be more proactive and involved in their billing cycle and the latest guidelines, are a remainder to stay in the loop !

Medicare Fraud one of the Biggest Exposes in Recent times

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The Biggest Expose in Recent times !

The healthcare industry is in the news once again. But this time, forentirely the wrong reasons. Medicare fraud has always been discussed about in hushed whispers. The lack of concrete evidence and mutual finger pointing ensured that allegations and counter allegations, soon faded into oblivion.

A 430 Million Dollar Scam.

We repeatedly hear of doctors being brought to book for billing errors. But more often than not it turns out to be miscommunication between the patient and doctor or not following revised guidelines. The recent expose that indicts over 90 physicians for submitting fraudulent bills and cheating medicare of four hundred and thirty dollars reveals a much darker story.

Higher Healthcare Costs… 

It is coordinated frauds like this that hike up the average patient’s bill, medico-legal experts allege. But the biggest fallout of this scam could be that physicians who make genuine mistakes with their bill could face more stringent action. Not to speak of the loss of faith and belief, of the public.

Steering Clear of the Muck.

Physicians will have to ensure that every claim sent out is thoroughly scrubbed and “clean”. A scam of this magnitude is certainly going to put everybody else in the scanner. And as skeletons keep tumbling out of the closet, the dust is not going to settle down anytime soon. Medical practices will have to be fully aware of, and pay close attention to the billing process.

The Man in the Mirror…

Like the cult song, nothing much is going to change if the man in the mirror refuses to change. No healthcare reform, billing audit or screaming headline is going to bring about a better and safer healthcare environment, unless physicians take it upon themselves to ensure their medical practice bills the right way ! Or call up their physician billing company to ensure that they’re following all billing regulations.